Subjective Memory Complaints With and Without Objective Memory Impairment: Relationship With Risk Factors for Dementia

doi:10.1097/00019442-200508000-00013

The American Journal of Geriatric Psychiatry

Volume 13, Issue 8, August 2005, Pages 731-734

https://doi.org/10.1097/00019442-200508000-00013 Get rights and content

Objective

The authors investigated the frequency distribution of well-established risk factors for dementia—high plasma homocysteine and the apolipoprotein E ε4 allele (APOE ε4)—among older women with subjective memory complaints (SMC) but no cognitive impairment, and with mild cognitive impairment (MCI).

Methods

This was a cross-sectional, community-based study.

Results

Women with MCI had higher total plasma homocysteine than healthy-comparison subjects. There was also a nonsignificant excess of APOE ε4 carriers in the MCI than in the healthy group. Participants with SMC had higher depression and anxiety scores than healthy-comparison subjects, but did not differ from subjects in the healthy-comparison group in relation to their total plasma homocysteine and APOE ε4 distribution.

Conclusions

MCI seems to be more closely related to well-established risk factors for dementia than is SMC.

Section snippets

METHODS

Community-dwelling women age 70 years or over, living in the metropolitan area of Perth, Western Australia, were recruited via advertisement in various media to participate as volunteers in a longitudinal research project investigating mental health and the quality of life of older women and its association with estrogen replacement. This study describes cross-sectional information obtained at their time of recruitment into that study. The following exclusion criteria applied: 1) Mini-Mental

RESULTS

A total of 264 women were included in the study; 106 did not report poor memory and had WL Delayed Recall scores ≥2; they were grouped under the heading of healthy-comparison group (HCG).

A group of 121 women complained of memory problems but did not display objective memory impairment, as defined by a score of 0 or 1 on the delayed component of the WL (SMC); 37 women (14% of the total sample) displayed objective memory impairment, with 28 of them also reporting subjective memory impairment

DISCUSSION

The results of this study showed that women with MCI have significantly higher plasma homocysteine levels than healthy-comparison subjects. We were unable to demonstrate a clear association between MCI and APOE ε4 genotyping, possibly because of insufficient study power. In contrast, participants with SMC did not differ from women in the healthy-comparison group in relation to their total plasma homocysteine or APOE genotype. They did differ, however, on BDI and BAI scores, as well as quality

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We performed a meta-analysis to assess the contribution of ML and neuropsychological measures for the automated classification of MCI patients and the prediction of their conversion to AD. The pooled sensitivity and specificity of patients’ classifications was obtained by means of a quantitative bivariate random-effect meta-analytic approach. Although a high heterogeneity was observed, the results of meta-analysis show that ML applied to neuropsychological measures can lead to a successful automatic classification, being more specific as screening rather than prognosis tool. Relevant categories of neuropsychological tests can be extracted by ML that maximize the classification accuracy.
Motoric cognitive risk syndrome: Integration of two early harbingers of dementia in older adults
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Dementia is characterized by a long preclinical phase that may last years to decades before the onset of mild cognitive impairment. Slow gait speed and subjective memory complaint commonly co-occur during this preclinical phase, and each is a strong independent predictor of cognitive decline and dementia. Motoric cognitive risk (MCR) syndrome is a pre-dementia syndrome that combines these two early harbingers of dementia. The risk of cognitive decline or dementia is stronger for MCR than for either slow gait speed or subjective memory complaint alone. Slow gait speed and subjective memory complaint have several common risk factors: cardiovascular disease, diabetes mellitus, abnormal cortisol profiles, low vitamin D levels, brain atrophy with decreased hippocampal volume, and increased deposition of beta-amyloid in the brain. The underlying pathogenesis of MCR remains poorly understood. Metabolomics and proteomics have great potential to provide new insights into biological pathways involved in MCR during the long preclinical phase preceding dementia.
Functional cognitive disorders: a systematic review
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Citation Excerpt :
56 studies described prevalence of cognitive symptoms in community populations (appendix pp 7–11), with a variety of assessment methods, finding symptoms in between 8% and 80%, with overall 30% of the 245 654 individuals included reported to have cognitive symptoms.74–129 Of those cross-sectional studies including objective measures of cognitive function, 18 studies found a positive association between symptoms and objective impairment,74–77,84–87,89,92,97,98,102,105,106,108,120,127 but 14 studies did not.79,81,83,95,96,99,104,113,117,119,126,128–130 Some reported symptom association with impairment in subgroups: specific rather than global cognitive symptoms,80 subjective cognitive decline with additional clinical or biomarkers suggesting neurodegenerative disease but not subjective cognitive decline alone,103 and only in male participants.91
Cognitive symptoms are common, and yet many who seek help for cognitive symptoms neither have, nor go on to develop, dementia. A proportion of these people are likely to have functional cognitive disorders, a subtype of functional neurological disorders, in which cognitive symptoms are present, associated with distress or disability, but caused by functional alterations rather than degenerative brain disease or another structural lesion. In this Review, we have systematically examined the prevalence and clinical associations of functional cognitive disorders, and related phenotypes, within the wider cognitive disorder literature. Around a quarter of patients presenting to memory clinics received diagnoses that might indicate the presence of functional cognitive disorders, which were associated with affective symptoms, negative self-evaluation, negative illness perceptions, non-progressive symptom trajectories, and linguistic and behavioural differences during clinical interactions. Those with functional cognitive disorder phenotypes are at risk of iatrogenic harm because of misdiagnosis or inaccurate prediction of future decline. Further research is imperative to improve diagnosis and identify effective treatments for functional cognitive disorders, and better understanding these phenotypes will also improve the specificity of diagnoses of prodromal degenerative brain disease.
Subjective Memory Complaints are Associated with Incident Dementia in Cognitively Intact Older People, but Not in Those with Cognitive Impairment: A 24-Month Prospective Cohort Study
2017, American Journal of Geriatric Psychiatry
Citation Excerpt :
In the present study, the risk of incident dementia was not significantly different in cognitively impaired participants with or without SMCs. In a previous study by Lautenschlager et al., the presence of cognitive impairment was a strong risk factor for dementia among older people, regardless of the association with SMCs.32 These results were supported by our findings.
Although subjective memory complaints (SMCs) are considered a risk factor for incident dementia in older people, the effect might differ based on cognitive function. The aim of the present study was to investigate whether the effect of SMCs on the incidence of dementia in older people differed based on cognitive function.
A 24-month follow-up cohort study.
Japanese community.
Prospective, longitudinal data for incident dementia were collected for 3,672 participants (mean age: 71.7 years; 46.5% men) for up to 24 months.
Baseline measurements included covariates for incident dementia, SMCs, and cognitive function. Associations between SMCs, cognitive impairment, and incident dementia were examined using Cox proportional hazards models.
Incidences of dementia in the cognitively intact without SMC, cognitively intact with SMC, cognitive impairment without SMC, and cognitive impairment with SMC groups were 0.3%, 1.8%, 3.4%, and 4.8%, respectively. In the cognitively intact participants, SMCs were associated with a significantly higher risk of dementia (hazard ratio [HR]: 4.95, 95% confidence interval [CI]: 1.52–16.11, p = 0.008). Incident dementia with cognitive impairment was not significantly different based on SMC presence (p = 0.527). Participants with cognitive impairment in multiple domains had a significantly higher risk of incident dementia (HR: 2.07, 95% CI: 1.01–4.24, p = 0.046)
SMCs were related with dementia in cognitively intact older people, but not in those with cognitive impairment.Multiple domains of cognitive impairment were associated with a higher risk of incident dementia.
An improved I-FAST system for the diagnosis of Alzheimer's disease from unprocessed electroencephalograms by using robust invariant features
2015, Artificial Intelligence in Medicine
This paper proposes a new, complex algorithm for the blind classification of the original electroencephalogram (EEG) tracing of each subject, without any preliminary pre-processing. The medical need in this field is to reach an early differential diagnosis between subjects affected by mild cognitive impairment (MCI), early Alzheimer's disease (AD) and the healthy elderly (CTR) using only the recording and the analysis of few minutes of their EEG.
This study analyzed the EEGs of 272 subjects, recorded at Rome's Neurology Unit of the Policlinico Campus Bio-Medico. The EEG recordings were performed using 19 electrodes, in a 0.3–70 Hz bandpass, positioned according to the International 10–20 System. Many powerful learning machines and algorithms have been proposed during the last 20 years to effectively resolve this complex problem, resulting in different and interesting outcomes. Among these algorithms, a new artificial adaptive system, named implicit function as squashing time (I-FAST), is able to diagnose, with high accuracy, a few minutes of the subject's EEG track; whether it manifests an AD, MCI or CTR condition. An updating of this system, carried out by adding a new algorithm, named multi scale ranked organizing maps (MS-ROM), to the I-FAST system, is presented, in order to classify with greater accuracy the unprocessed EEG's of AD, MCI and control subjects.
The proposed system has been measured on three independent pattern recognition tasks from unprocessed EEG tracks of a sample of AD subjects, MCI subjects and CTR: (a) AD compared with CTR; (b) AD compared with MCI; (c) CTR compared with MCI. While the values of accuracy of the previous system in distinguishing between AD and MCI were around 92%, the new proposed system reaches values between 94% and 98%. Similarly, the overall accuracy with best artificial neural networks (ANNs) is 98.25% for the distinguishing between CTR and MCI.
This new version of I-FAST makes different steps forward: (a) avoidance of pre-processing phase and filtering procedure of EEG data, being the algorithm able to directly process an unprocessed EEG; (b) noise elimination, through the use of a training variant with input selection and testing system, based on naïve Bayes classifier; (c) a more robust classification phase, showing the stability of results on nine well known learning machine algorithms; (d) extraction of spatial invariants of an EEG signal using, in addition to the unsupervised ANN, the principal component analysis and the multi scale entropy, together with the MS-ROM; a more accurate performance in this specific task.
Predicting cognitive, functional, and diagnostic change over 4 years using baseline subjective cognitive complaints in the Sydney Memory and Ageing Study
2015, American Journal of Geriatric Psychiatry
Citation Excerpt :
However, investigation of the associations between SCCs and objective cognitive performance,7–13 MCI,9,11,14 and future dementia9,15 in cross-sectional and longitudinal studies has yielded mixed results.16 Strong associations have consistently been reported between SCCs and depression,8,10,16,17 anxiety,10,16,17 and personality traits,18 including neuroticism, openness, and conscientiousness.16 Differences between studies might be explained by definitional and methodologic issues.
There is limited understanding of the usefulness of subjective cognitive complaint(s) (SCC) in predicting longitudinal outcome because most studies focus solely on memory (as opposed to nonmemory cognitive) complaints, do not collect data from both participants and informants, do not control for relevant covariates, and have limited outcome measures. Therefore the authors investigate the usefulness of participant and informant SCCs in predicting change in cognition, functional abilities, and diagnostic classification of mild cognitive impairment or dementia in a community-dwelling sample over 4 years.
Nondemented participants (N = 620) in the Sydney Memory and Ageing Study aged between 70 and 90 years completed 15 memory and 9 nonmemory SCC questions. An informant completed a baseline questionnaire that included 15 memory and 4 nonmemory SCC questions relating to the participant. Neuropsychological, functional, and diagnostic assessments were carried out at baseline and again at 4-year follow-up. Cross-sectional and longitudinal analyses were carried out to determine the association between SCC indices and neuropsychological, functional, and diagnostic data while controlling for psychological measures.
Once participant characteristics were controlled for, participant complaints were generally not predictive of cognitive or functional decline, although participant memory-specific complaints were predictive of diagnostic conversion. Informant-related memory questions were associated with global cognitive and functional decline and with diagnostic conversion over 4 years.
Informant memory complaint questions were better than participant complaints in predicting cognitive and functional decline as well as diagnoses over 4 years.

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We thank Kellie Cassidy, Dr. Ria Kotynia, Lee Barclay, Felicity Roche, Dr. Brett Coulson, Dr. Steve Fenner, Dr. Helen McGowan, and Tricia Knox for their assistance with data collection and management. The investigators gratefully acknowledge the generous contribution of the women who took part in this study.

This project was supported by a grant from the National Health and Medical Research Council of Australia (NHMRC).

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Brief ReportSubjective Memory Complaints With and Without Objective Memory Impairment: Relationship With Risk Factors for Dementia

Objective

Methods

Results

Conclusions

Section snippets

METHODS

RESULTS

DISCUSSION

Lancet

Prospects for the prevention of dementia

Aus J Ageing

Are memory complaints predictive for dementia? a review of clinical and population-based studies

Int J Geriatr Psychiatry

Effects of age, sex, and ethnicity on the association between apolipoprotein-E genotype and Alzheimer disease

JAMA

Plasma homocysteine as a risk factor for dementia and Alzheimer's disease

New Engl J Med

Brief Report
Subjective Memory Complaints With and Without Objective Memory Impairment: Relationship With Risk Factors for Dementia